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Issue Alert - 08-03-01

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Date:

Mar 15, 2008

Program Area:

Medicaid (MA)

Issue Summary:

Individuals seeking Medicaid will have longer to spend their retroactive Supplemental Security Income (SSI) and Social Security (RSDI) benefits under new policy excluding the retroactive awards as being counted as assets for 9 months after they are received, when determining eligibility for “SSI-related Medicaid” (Medicaid for persons who are disabled, blind or elderly (65+) )

Persons Affected:

Medicaid applicants or recipients who have received an award of retroactive SSI or RSDI benefits

For More Information:

Center for Civil Justice 320 S. Washington, 2nd Floor Saginaw, MI 48607 (989) 755-3120, (800)724-7441 Fax: (989) 755-3558 E-mail: info@ccj-mi.org

Michigan Poverty Law Program 611 Church Street, Suite 4A Ann Arbor, MI 48104-3000 (734) 998-6100 (734) 998-9125 Fax


Background

Medicaid has dozens of eligibility “categories”.   Categories that provide coverage to individuals because they are aged (age 65 or older), blind, or disabled are known as “SSI-related” categories. 

See DHS Program Eligibility Manual (PEM) Item 105.   (DHS manuals and policies are available online at http://www.mfia.state.mi.us/olmweb/ex/html/.)  As the name suggests, eligibility for SSI related Medicaid categories must be determined using the same “methodology” as the SSI program.   Therefore, assets or income that is not counted when determining SSI eligibility also must be excluded when determining eligibility for SSI-related Medicaid categories. See 42 USC 1396a(a)(10)(C)(i)(III) and 1396a(r)(2); 42 CFR 435.601(d). 

Michigan’s SSI-related Medicaid policy on “assets” only excludes retroactive SSI and Social Security awards from being counted as assets for six months after they are received.   PEM 400 p. 12-13.   For SSI eligibility, however, retroactive SSI and Social Security benefits are not counted as assets for nine months after they are received.  42 USC 1382b(a)(7).

What's Happening?

As the result of advocacy by Deb Hemgesberg at the Association for Community Advocacy, the Medicaid agency has agreed that the policy in PEM 400 is incorrect and retroactive SSI and Social Security awards must be excluded as assets for 9 months, rather than 6 months. 

A new version of PEM 400 should be issued in July 2008.  Until that time, the Medicaid agency has indicated that Department of Human Services (DHS) workers will be alerted to the change from 6 months to 9 months through a "clarification" that will be posted in PEM 400.  We expect that this “clarification” or posting will be available on the DHS intranet version of policy but will NOT be on the internet version.

What Should Advocates Do?

Watch for clients who may be threatened with termination or denial of Medicaid based on retroactive SSI or RSDI benefits that were received more than 6, but less than 9, months previously.

Ask DHS workers to check for the clarification that should be posted in PEM 400 if your clients encounter this problem.

Remember that clients will be asset eligibility for SSI-related Medicaid if their assets are below the asset limit for at least one day in the month for which they are seeking eligibility.

2.  When you successfully represent clients in SSI and RSDI cases, give accurate advice on the length of time (9 months) that they have to spend the retroactive benefits before they will be counted as assets that may affect Medicaid eligibility.

Advise clients that it is best to keep retroactive benefits in a separate account (don’t commingle with other funds) so that it will be clear which funds are not countable.

Advise clients that they should get legal advice immediately if they are threatened with termination or denial of Medicaid based on retroactive SSI or RSDI benefits that were received more than 6, but less than 9, months previously.

3.  Share this information with other practitioners who handle SSI or RSDI cases.

What Should Clients Do?

1.     Keep track of the 9 month deadline after which your retroactive award of SSI or RSDI will counted toward your Medicaid asset limit.  

2.     Keep your retroactive award in a separate bank account, if possible.

3.     Do not ignore notices about Medicaid terminations – you must request a hearing before the scheduled date of the termination to keep your Medicaid while your hearing request is pending.  DHS must receive your original, signed hearing request before that scheduled termination date.

Get legal advice is you are threatened with termination of Medicaid or are denied Medicaid.

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee.

You can locate various sources of legal and related services, including the free legal aid office that serves your county, at MichiganLegalAid.org.

You can also look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.